Provider Demographics
NPI:1982883229
Name:VISION ARTS EYE CARE CENTER OF PERRY INC
Entity type:Organization
Organization Name:VISION ARTS EYE CARE CENTER OF PERRY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:WYATT
Authorized Official - Middle Name:R
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:850-584-2408
Mailing Address - Street 1:1502 S JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:PERRY
Mailing Address - State:FL
Mailing Address - Zip Code:32348-5601
Mailing Address - Country:US
Mailing Address - Phone:850-584-2408
Mailing Address - Fax:850-838-1833
Practice Address - Street 1:1502 S JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:PERRY
Practice Address - State:FL
Practice Address - Zip Code:32348-5601
Practice Address - Country:US
Practice Address - Phone:850-584-2408
Practice Address - Fax:850-838-1833
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-02
Last Update Date:2009-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC00784152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL084155200Medicaid
FLK9042Medicare UPIN
FL5607310001Medicare NSC
FLK9042Medicare PIN